心肌灌注显像剂^99mTc—tetrofosmin的临床应用

2000年12月13日,辽宁省某大型国营企业工业加速器探伤机在操作过程中发生了意外照射事件,事件的起因主要是由于人为因素所导致,虽然受照人员没有受到严重大剂量照射,但本次事件应引起相关人员的足够重视,并引以为戒以防类似事件再次发生。下面将这次意外照射的过程简要介绍如下。     

腹部手术后患者血浆谷氨酰胺的变化及对肠道通透性的影响

目的：观察腹部手术后血浆Ｇｌｎ浓度变化及对肠道通透性的影响。     

^99Tc^m—DTPA肾动态显像对上尿路结石症的临床价值

目的探讨^99Tc^m-DTPA（二乙烯三胺五醋酸）肾动态显像对上尿路结石患者诊断和治疗的临床价值。方法回顾性分析因上尿路结石行^99Tc^m-DTPA肾动态显像且随访资料完整的患者49例，患病肾脏共61只，根据首次肾动态显像检查患肾的功能状况进行分组，统计患肾的肾小球滤过率（GFR）、20min排泄率（R20）。结果^99Tc^m-DTPA肾动态显像共提示上尿路梗阻或不完全梗阻肾脏57只，诊断阳性率为93．4％（57／61），解除梗阻后3个月肾功能明显改善但程度不等，解除梗阻前肾功能重度受损者其GFR和R20恢复差。13例（13／49）肾功能重度受损患者进行了患侧。肾脏摘除手术。结论上尿路梗阻患者及时进行肾动态显像检查，对临床治疗方法选择具有明显的指导意义。早期了解患肾功能并及时解除梗阻，可以最大限度地恢复和保留患肾功能，避免最终可能导致的患肾摘除.     

^99Tc4^mO^-SPECT显像与CT对甲状腺癌诊断价值的对比研究

目的评价甲状腺99Tc4mO-SPECT显像与CT对甲状腺癌的诊断价值。方法对32例同期兼作甲状腺99Tc4mO-SPECT显像与CT扫描的甲状腺癌影像学表现进行对比分析,并与临床手术及病理结果对照。结果32例甲状腺癌共有39个病灶,CT检出33个病灶(85%),核素扫描检出23个(59%),两种检查方法在病灶检出方面差异有统计学意义(P=0.002)。CT扫描显示8例出现瘤周“半岛状”瘤结节,4例瘤周“残圈”征;7例细颗粒钙化,2例粗钙化,4例混合性钙化,20例肿瘤侵犯周围组织器官,15例出现颈部淋巴结转移,诊断符合率72%9。9Tc4mO-SPECT显像显示冷结节16例,凉结节3例,结节性甲状腺肿8例,甲状腺显像未见异常2例,2例显影模糊,甲状腺区未见显影1例,诊断符合率为59%。结论甲状腺癌的CT表现具有一定特征性,CT在对甲腺病变定性诊断方面优于99Tc4mO-SPECT显像;作为常规甲状腺疾病检查的99Tc4mO-SPECT平面显像主要用于筛选诊断,对甲状腺肿瘤定性诊断作用有限,有必要作进一步检查。     

采用高效液相色谱法检测儿童肠道通透性的方法学研究

【目的】建立通过双糖吸收试验评价儿童肠粘膜屏障功能的高效液相色谱法(highperformanceliquidchromatography,HPLC)。【方法】采用HPLC法检测研究对象尿液标本中甘露醇(mannitol,M)和乳果糖(lactulose,L)排出率比值。以Sugar-Pak1(300×6.5mm,Waters)为色谱柱;柱温:85℃;流动相:超纯水;流速:O.5ml／min;示差折射检测器。【结果】在上述色谱条件下,尿液中甘露醇和乳果糖能得到良好分离。该法检测甘露醇和乳果糖排出量的平均日内变异系数分别为2.51％和3.03％(n=4);日间变异系数分别为3.53％和5.52％;甘露醇的加样回收率在93％~98％之间,乳果糖的加样回收率在91％~97％之间。本方法测定甘露醇的最大检出限为25mg／L,乳果糖为12.5mg／L。食物过敏儿童肠道通透性(L／M:0.18±0.06)较正常儿童(L／M:0.05±0.03)显著增高(P<0.001)。【结论】HPLC检测肠道通透性的准确性高、重复性好,是临床评价小肠粘膜屏障功能的实用方法。     

肠内营养对活动期溃疡性结肠炎患者肠道通透性的影响

目的 探讨肠内营养(EN)对活动期溃疡性结肠炎患者肠道通透性的影响。方法 采用随机数字表法将24例轻、中度活动期溃疡性结肠炎患者分为常规组(n=11)和常规+ EN组(n=13),分别给予美沙拉秦+少渣饮食治疗和美沙拉秦+短肽型肠内营养剂治疗14 d。采用高压液相色谱分析法分别检测治疗前后患者尿液中乳果糖及甘露醇的浓度,计算乳果糖/甘露醇排泄率的比值(L/M)。结果 治疗前常规组和常规+ EN组的L/M分别为0.039±0.025和0.072±0.019,两组的差异无统计学意义(P=0.069)。治疗2周后,常规+EN组的L/M为0.038±0.012,明显低于治疗前(P =0.043),常规组的L/M为0.032±0.022,与治疗前的差异无统计学意义(P=0.730)。结论 EN可以降低活动期溃疡性结肠炎患者的肠道通透性。     

内毒素对胃肠通过时间及肠通透性的作用

应用6周龄的白鼠注射内毒素（E．coli0111：B4）的方法以评价胃肠通过时间，肌酐清除率，双糖（乳果糖、甘露醇）的肠道通透性。给予~（51）铬－依地酸动态监测通过消化道时间表明，内毒素组胃排空时间比生理盐水对照组明显延长（t1／2＝26±2vs162±20minP＜0．01），小肠运行时间无明显改变（81±17vs93±29min）。通过尿中乳果糖／甘露醇排泄比来评定肠通透性，内毒素组通透性比对照组高（1．01±0．08vs0．60±0．04P＜0．01）。在测试期测定小肠有效吸收标记物数量以校正个别糖排泄后，结果是内毒素可使乳果糖吸收增加，但甘露醇吸收无改变。本研究也提示内毒素血症（通过药物或其它治疗后无并发症）能使胃排空时间明显延长，于是影响到口服或鼻胃管喂养的耐受性。     

胰腺癌病人肠道通透性改变及其与血清蛋白关系的临床研究

目的:观察胰腺癌病人肠道通透性和营养状况的改变,初步探讨它们之间的关系. 方法:选取胰腺癌首次入院确诊的病人及健康志愿者各15例,作为试验组和对照组.分别测定尿乳果糖/甘露醇(L/M)比值、血清肿瘤坏死因子(TNF-α)、清蛋白(ALB)、转铁蛋白(TF)和前清蛋白(PA),并对试验组的肠道通透性与血清TNF-α水平、血清蛋白之间的相关性进行分析. 结果:试验组尿L/M比值显著高于对照组(0.331±0.343 vs 0.129± 0.136,P＜ 0.05).试验组血清TNF-α显著高于对照组,(4.98±6.46)ng/L vs (1.25±2.35)ng/L,P ＜0.05.试验组ALB、TF、PA浓度均较对照组显著降低(P ＜0.05).试验组尿L/M比值与血清TNF-α水平呈极显著正相关(P＜ 0.01)而与ALB、TF、PA均呈极显著的负相关(P＜0.01). 结论:胰腺癌病人肠道通透性增加与血清TNF-α水平升高呈显著正相关,与血清蛋白下降呈显著负相关.     

^99Tc-亚甲基二磷酸盐对^131Ⅰ治疗后Graves眼病转归的影响

目的观察102例伴有突眼的Graves眼病患者^131Ⅰ治疗后的疗效,探讨^99Tc-亚甲基二磷酸盐（^99Tc-MDP,云克）对^131Ⅰ治疗后Graves眼病转归的影响。方法102例Graves眼病患者随机分成云克治疗组56例和对照组46例,全部病例均按照常规程序接受^131Ⅰ治疗。治疗结束后6个月门诊随访疗效。结果^131Ⅰ治疗后甲状腺功能亢进（甲亢）痊愈及好转的患者中,云克治疗组64.3％（27／42）的患者Graves眼病得到缓解;即使^131Ⅰ治疗后发生甲状腺功能减退（甲低）,云克治疗组Graves眼病的总有效率仍高达66．7％（8／12）,与对照组（O）比较差异有统计学意义（P〈0．01）。结论云克治疗可作为合并有Graves眼病的甲亢患者^131Ⅰ治疗前的一种有效的辅助治疗措施,提高^131Ⅰ治疗后Graves眼病的缓解率,在一定程度上可防止甲低发生时加重突眼。     

术后早期肠道通透性改变及其与全身炎症反应的关系

目的 :通过观察胃肠道应用谷氨酰胺 (glutamine ,Gln)对腹部手术后病人早期肠道通透性的影响 ,继而探讨其与全身炎症反应的关系。　方法 :2 0例腹部手术病人以前瞻、双盲、随机的方法分为Gln组和对照组 ,每组各 10例。从术后第 1天开始 ,Gln组每天胃肠道应用Gln颗粒剂 30 g ,共 7天 ;对照组每天应用安慰颗粒剂 30 g ,共 7天。于用药前、后分别检测血清Gln浓度和反映肠道通透性与全身炎症反应有关的实验指标 [尿乳果糖 /甘露醇比值(lactulose/mannitol,L/M)、血清二胺氧化酶、内毒素、丙二醛 ]和临床表现 (体温、心率和血白细胞计数 )。　结果 :对照组的血清Gln浓度从用药前 (432 .17± 14 2 .6 8) μmol/L下降至用药后 (2 5 0 .78± 77.10 ) μmol/L(P <0 .0 1) ,Gln组则由用药前 (36 1.17± 16 1.2 5 ) μmol/L升高至用药后 (5 83.2 2± 171.5 2 ) μmol/L(P <0 .0 5 )。对照组和Gln组用药前尿L/M比值分别是 134.0 0± 18.4 8和 14 6 .10± 2 0 .2 1(P >0 .0 5 ) ,用药后对照组尿L/M比值显著升高 ,Gln组则显著降低 ,分别是 194 .83± 4 5 .31和 117.4 7± 2 5 .6 8,组间比较差异非常显著 (P <0 .0 1)。用药 7天后 ,Gln组的血清二胺氧化酶、内毒素、丙二醛均较用药前显著降低。反映全身炎症反应的临床指     

谷氨酰胺对创伤后肠粘膜通透性的影响

在创伤的情况下,肠道通透性将发生改变,继而引起细菌移位和内毒素血症。谷氨酰胺可以通过降低肠粘膜通透性来减少细菌移位、减轻内毒素血症。     

升结肠支撑管腹膜炎动物模型的建立

目的:建立弥漫性腹膜炎动物模型,并观察不同程度弥漫性腹膜炎对肠黏膜通透性的影响。方法:采用升结肠支撑管腹膜炎模型(CASP)诱发弥漫性腹膜炎。将小鼠随机分为对照组、假手术组、和支撑管1.3mm组和1.7mm组。观察术后72h各组的生存率。并于术后18h比较肠黏膜通透性的变化。结果:升结肠支撑管内径越大,造成弥漫性腹膜炎小鼠死亡率越高。1.3mm组和1.7mm组术后72h累积生存率分别为75%和44%。1.7mm组肠道通透性高于1.3mm组。结论:CASP模型较好地模拟了急性弥漫性腹膜炎。当支撑管内径为1.7mm时,可模拟重度急性弥漫性腹膜炎,而当支撑管内径为1.3mm时则可模拟轻度急性弥漫性腹膜炎。     

Alcohol, intestinal bacterial growth, intestinal permeability to endotoxin, and medical consequences: summary of a symposium.

This report is a summary of the symposium on Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences, organized by National Institute on Alcohol Abuse and Alcoholism, Office of Dietary Supplements, and National Institute of Diabetes and Digestive and Kidney Diseases of National Institutes of Health in Rockville, Maryland, October 11, 2006. Alcohol exposure can promote the growth of Gram-negative bacteria in the intestine, which may result in accumulation of endotoxin. In addition, alcohol metabolism by Gram-negative bacteria and intestinal epithelial cells can result in accumulation of acetaldehyde, which in turn can increase intestinal permeability to endotoxin by increasing tyrosine phosphorylation of tight junction and adherens junction proteins. Alcohol-induced generation of nitric oxide may also contribute to increased permeability to endotoxin by reacting with tubulin, which may cause damage to microtubule cytoskeleton and subsequent disruption of intestinal barrier function. Increased intestinal permeability can lead to increased transfer of endotoxin from the intestine to the liver and general circulation where endotoxin may trigger inflammatory changes in the liver and other organs. Alcohol may also increase intestinal permeability to peptidoglycan, which can initiate inflammatory response in liver and other organs. In addition, acute alcohol exposure may potentiate the effect of burn injury on intestinal bacterial growth and permeability. Decreasing the number of Gram-negative bacteria in the intestine can result in decreased production of endotoxin as well as acetaldehyde which is expected to decrease intestinal permeability to endotoxin. In addition, intestinal permeability may be preserved by administering epidermal growth factor, l-glutamine, oats supplementation, or zinc, thereby preventing the transfer of endotoxin to the general circulation. Thus reducing the number of intestinal Gram-negative bacteria and preserving intestinal permeability to endotoxin may attenuate alcoholic liver and other organ injuries.     

丙氨酰-谷氨酰胺双肽对术后肠道通透性和全身炎性反应的影响

目的:观察丙氨酰-谷氨酰胺(Aln-Gln)双肽对腹部手术后病人早期肠道通透性的影响,并探讨其与术后全身炎性反应的关系。方法:20例腹部手术病人分为研究组和对照组,每组各10例。从术后第1天开始,研究组静脉供给Aln-Gln双肽0.5 g/(kg.d),共4 d;对照组用同等容量生理盐水替代。于手术前、后分别检测血浆Gln浓度、尿乳果糖/甘露醇比值(L/M)、血浆二胺氧化酶(DAO)、白细胞介素-6(IL-6)和临床指标(体温、心率、呼吸和血白细胞计数)等。结果:术后第5天,对照组病人的血浆Gln浓度较术前下降16%,研究组较术前升高17%,且研究组显著高于对照组(P0.05)。研究组病人术后第5天尿L/M、血浆DAO和IL-6显著低于对照组;研究组病人术后全身炎症反应综合征(SIRS)的发生率亦显著低于对照组。结论:术后静脉供给Aln-Gln能提高血浆Gln浓度,改善肠屏障功能,减轻术后早期全身炎性反应,有利于术后的快速康复。     

胰腺癌病人肠道通透性改变及其与机体组成的关系

目的:观察胰腺癌病人肠道通透性与机体组成的改变,并初步探讨两者间的关系.方法:以前瞻、随机和对照的方法,选取确诊胰腺癌首次入院的病人及健康志愿者各15例,作为试验组和对照组,测定尿乳果糖/甘露醇(L/M)比值、血清肿瘤坏死因子-α(TNF-α)和机体组成成分,并对试验组的肠道通透性L/M比值与血清TNF-α水平、机体组成之间的相关性进行分析.结果:①试验组尿L/M比值为0.331±0.343显著高于对照组0.129±0.136(P《0.05);血清TNF-α水平显著高于对照组(P《0.05).②试验组肌肉群重量显著低于对照组(P《0.05)、蛋白质重量极显著低于对照组(P《0.01)、而脂肪、水分、无机盐重量略轻于对照组,两组间差异无显著性意义.③试验组尿L/M比值与血清TNF-α水平呈极显著性正相关(P《0.01);尿L/M比值与蛋白质、脂肪呈极显著性负相关(P《0.01),与水分呈极显著性正相关(P《0.01);而试验组血清TNF-α浓度与蛋白质、脂肪呈极显著性负相关(P《0.01)、与水分呈极显著性正相关(P《0.01).结论:胰腺癌病人肠道的通透性增加,机体组成有显著改变,两者间密切相关.这可能与血清TNF-α水平的升高有关.     

Cellular Zn depletion by metal ion chelators (TPEN, DTPA and chelex resin) and its application to osteoblastic MC3T3-E1 cells

Trace mineral studies involving metal ion chelators have been conducted in investigating the response of gene and protein expressions of certain cell lines but a few had really focused on how these metal ion chelators could affect the availability of important trace minerals such as Zn, Mn, Fe and Cu. The aim of the present study was to investigate the availability of Zn for the treatment of MC3T3-E1 osteoblast-like cells and the availability of some trace minerals in the cell culture media components after using chelexing resin in the FBS and the addition of N,N,N'',N''-tetrakis-(2-pyridylmethyl)ethylenediamine (TPEN, membrane-permeable chelator) and diethylenetriaminepentaacetic acid (DTPA, membrane-impermeable chelator) in the treatment medium. Components for the preparation of cell culture medium and Zn-treated medium have been tested for Zn, Mn, Fe and Cu contents by atomic absorption spectrophotometer or inductively coupled plasma spectrophotometer. Also, the expression of bone-related genes (ALP, Runx2, PTH-R, ProCOL I, OPN and OC) was measured on the cellular Zn depletion such as chelexing or TPEN treatment. Results have shown that using the chelexing resin in FBS would significantly decrease the available Zn (p<0.05) (39.4 ± 1.5 µM vs 0.61 ± 10.15 µM) and Mn (p<0.05) (0.74 ± 0.01 µM vs 0.12 ± 0.04 µM). However, levels of Fe and Cu in FBS were not changed by chelexing FBS. The use of TPEN and DTPA as Zn-chelators did not show significant difference on the final concentration of Zn in the treatment medium (0, 3, 6, 9, 12 µM) except for in the addition of higher 15 µM ZnCl₂ which showed a significant increase of Zn level in DTPA-chelated treatment medium. Results have shown that both chelators gave the same pattern for the expression of the five bone-related genes between Zn- and Zn+, and TPEN-treated experiments, compared to chelex-treated experiment, showed lower bone-related gene expression, which may imply that TPEN would be a stronger chelator than chelex resin. This study showed that TPEN would be a stronger chelator compared to DTPA or chelex resin and TPEN and chelex resin exerted cellular zinc depletion to be enough for cell study for Zn depletion.